Abstract: Therapists know the importance of home carryover and HEP compliance, but how can we increase follow through with our recommended home exercise programs? We will discuss factors contributing to compliance, strategies to improve rapport with client's and their families and considerations to create functional and effective HEP recommendations.
Description: Have you ever felt like you’re wasting your time giving parents or caregivers home exercise program recommendations? Another articulation word list to practice or worksheet with strategies that probably won’t even make it out of the car. A client who is seen in therapy for 1 hour/week will receive skilled services for less than 2% of their waking hours during a typical week. As therapists, we understand that it’s going to take more than 2% exposure and effort to attain the critical skills we are addressing in therapy. It doesn't matter if we are targeting a speech sound disorder, language impairments, feeding and swallowing difficulties or cognition in pediatric or adult populations or if we work in inpatient, outpatient or home health settings. Regardless of these specifics, carryover outside of our sessions will be necessary to generalize our progress and make our therapy meaningful to our client's daily lives. The development of skills requires consistent carryover of strategies and practicing targets throughout the other 98% of time a client isn’t with us. So, what can we do to help parents and caregivers increase their implementation of HEP?
As a pediatric SLP working in a busy outpatient rehab clinic and also being somewhat new to the field of speech language pathology I found myself getting discouraged by inconsistent or limited carryover of the HEP I provided to some parents. I was making an effort to send home materials and model strategies for parents but could tell they weren't being implemented. I could see such a big difference in the progress a client would make when skills were being targeted in the home outside of our sessions. I began compiling resources to help improve my home program recommendations and carryover for my client’s. I found it valuable to understand the variety of factors impacting poor compliance and also reflected on the importance of building strong relationships with my client's and their families. The proposed presentation is built from the information I have found from research as well as my clinical experience in practice thus far. This presentation is meant to increase awareness for the importance of HEPs and act as a call to action to other therapists to improve the HEPs they provide to client's.
Presentation Agenda:
Begin with audience participation: poll to get more information about audience's work settings and their thoughts/assumptions about client non-compliance with HEP (e.g. frequency, potential causes- is it due to limited time, poor motivation, etc).
The following areas will then be covered during presentation: -Common reasons or contributing factors to poor HEP compliance including: Chronic disabilities and parental stress (Rone-Adams, S.A. et al, 2004), Effect of parental collaboration in HEP formulation (Schreiber, J.M. et al, 1995)
-Importance of increasing parent/caregiver "buy in" to help promote HEP implementation by providing data to support HEP compliance ("Completion of home program linked to greatest communication gains", The ASHA Leader 2020) This article includes NOMS data between 1999 to 2018 which shows increased gains in communication when "some" or "all" of home exercise program was followed versus "none".
-How the parent/caregiver’s understanding of the task or goal impacts HEP compliance (Hines, D. et al, 2020) (Maas, E., et al, 2008). How can we expect parents or caregivers to teach things that they do not understand or maybe can't do themselves?
-Impact of therapist, client and parent/caregiver rapport and strategies to improve communication and relationships with families (An & Palisano, 2013) (Melvin, K et.al, 2019)
-Mindful selection of HEP targets to set families up for success and managing behaviors and expectations related to HEP. We have to make sure that we're setting up families for success as much as possible.
-Incorporating motivational interviewing techniques and verbiage when reviewing home exercise compliance and recommendations. Examples of how to word things to make the greatest impact and strongest case for follow through of your recommendations.
After presenting the above information there will be audience discussion regarding 1-2 example scenarios/case studies following presentation. Small group discussion depending on number of participants.
The outlined presentation agenda contains information that is important to increase awareness and provide strategies for creating strong evidence based home exercise program recommendations that are likely to be followed by the clients and families that we serve. I feel it is important to share this information with my peers to increase their knowledge and confidence in creating and sharing HEPs that can be successfully implemented by families. Additionally, due to the broad nature and applicability of the covered topics to many different areas of our field this presentation will be relevant and useful to therapists treating a variety of populations or in different settings.
Presentation Format & Methods: PowerPoint Interactive lecture and audience participation questions - poll regarding which work settings/populations and thoughts on HEP compliance factors Discussion on case study/example scenarios Handouts containing infographics/statistics that can be shared with clients and their families to increase implementation of provided information
Supporting Research: Reference 1: Rone-Adams, S. A., Stern, D. F., & Walker, V. (2004). Stress and compliance with a home exercise program among caregivers of children with disabilities. Pediatric Physical Therapy, 16(3), 140–148. https://doi.org/10.1097/01.pep.0000136006.13449.dc
Supporting Research: Reference 2: Melvin, K., Meyer, C., & Scarinci, N. (2019). What does “engagement” mean in early speech pathology intervention? A qualitative systematised review. Disability and Rehabilitation, 42(18), 2665–2678. https://doi.org/10.1080/09638288.2018.1563640
Supporting Research: Reference 3: An, M., & Palisano, R. J. (2013). Family–professional collaboration in pediatric rehabilitation: A practice model. Disability and Rehabilitation, 36(5), 434–440. https://doi.org/10.3109/09638288.2013.797510
Supporting Research: Reference 4: Completion of home program linked to greatest communication gains. (2020). The ASHA Leader, 25(2), 28–28. https://doi.org/10.1044/leader.noms.25032020.28
Supporting Research: Reference 5: Hines, D., York, K., & Kaul, E. (2020). Optimizing compliance with home programming through neuroplasticity education among parents of children receiving outpatient OT. The American Journal of Occupational Therapy, 74(4_Supplement_1). https://doi.org/10.5014/ajot.2020.74s1-po3133
Learning Objectives:
Describe 3 factors contributing to compliance and participation in home exercise programs by parents and caregivers.
Apply 5 strategies to increase compliance with therapist provided Home Exercise Program (HEP) and increase carryover of therapist recommendations.
Utilize 3 strategies to build a stronger rapport with client's and their family in order to promote generalization and carryover of therapy strategies into the home environment.
Create home exercise programs more specific to their client's needs using recommendations and strategies provided during this presentation.